For Lack of Teachers, Students Are Turned Away From Nursing

With the American government predicting a nationwide shortfall of more than 800,000 nurses by 2020, and as the health care needs of an aging population increase, it should be reassuring news that the number of those drawn to nursing careers is rising.

The National League for Nursing reported a 16 percent increase in applicants to bachelor’s degree nursing programs and a 28 percent increase in applicants to associate degree programs last year, compared with the year before. Yet nursing schools turned away almost 150,000 qualified applicants in 2005 — up 18 percent over the previous year. The reason? They don’t have enough teachers.

When Lia Welsch applied to six nursing schools in the fall of 2004, she was surprised to be accepted at just two and wait-listed or rejected at the others. Ms. Welsch has an undergraduate degree in molecular biology from Princeton University and a master’s degree in anatomy and neurobiology from Boston University School of Medicine.

“I wasn’t expecting that, because of my G.P.A., test scores and educational background,” said Ms. Welsch, who spent $1,000 to hold spots at Boston College and Yale while she waited for a spot at the University of Pennsylvania. She is now a nursing graduate student there, admitted about four weeks before the semester began.

Afaf I. Meleis, dean of the school, said Penn’s wait-list results largely from a shortage of faculty and a lack of clinical placements for students. Many say those two are essentially the same. In clinical placements, when student nurses work with patients in a hospital, faculty members must supervise. “I think we should be very alarmed about this,” said Ruth Corcoran, chief executive of the nursing league. “Some nursing schools have wait lists of two years.”

The main cause of the faculty shortage is salary. Academics make an average of 40 to 50 percent less than those working in clinical settings. Felissa R. Lashley, dean of Rutgers University College of Nursing in Newark, said she turned away “hundreds of qualified nursing applicants each year” because of a shortage of faculty members. Nurses with Ph.D.’s have numerous career choices in senior management, which pay far more than teaching. “I just lost someone for $60,000 more than they were making here,” Ms. Lashley said. “I would love to have been able to compete with that, but I can’t.”

C. Alicia Georges, an associate professor and chairwoman of the nursing department at CUNY Lehman College in the Bronx, has been trying for months to persuade a Ph.D. to leave her hospital job for a teaching position at Lehman. “She makes $120,000 managing a hospital unit,” Ms. Georges said. “All I can offer is $61,000.”

Like other nursing schools, Lehman often uses part-time instructors — usually a nurse with a master’s degree and a particular specialty — to fill in for the lack of full-timers. Pace University Lienhard School of Nursing in Westchester and Manhattan has created some nontenured positions called clinical instructors, but ideally, said the school’s dean, Harriet R. Feldman, all instructors should have Ph.D.’s. “That’s where the critical shortage is: full-time, tenure-track faculty.”

Compounding the salary issue is the age issue. According to the American Association of Colleges of Nursing, the average age of a nursing professor is 57. “The average age of faculty here at Penn is 49½,” Ms. Meleis said. “They get here and retire within 10 years.”

Photo

Lia Welsch, a nursing student in Pennsylvania, monitors a simulated patient.Credit
Mike Mergen for The New York Times

Nursing school deans say that if more nursing professors were given joint appointments — paid both for working at a hospital and teaching at a college — faculty salaries would be competitive with salaries outside academia. Joint appointments are permitted at Columbia University School of Nursing, where money earned from a clinical practice is paid to the university and the faculty member gets one paycheck, a combination of teaching and practice salaries. They also receive full university benefits, said the school’s dean, Mary O’Neil Mundinger.

“A faculty member can make $135,000 a year in clinical practice and $90,000 a year as a clinical professor,’’ she said. “I cut back their teaching proportionate to clinical practice needs, and I have hardly any turnover.”

Senator Charles E. Schumer, Democrat of New York, was a leader in the effort to pass the Nurse Reinvestment Act in 2001, which authorized new programs to increase the number of nurses and improve the quality of nursing services. Raising faculty salaries, Mr. Schumer said, is “the best and cheapest way to relieve the shortage.”

Concerns about aging faculty would be less pressing if nurses began their academic careers at an earlier age. For that to happen, nursing school deans say that students need a more direct route to a Ph.D. than the traditional, meandering one, where a nurse gets a bachelor’s and then works for several years before going back to school.

Right now the average age at which a nurse completes a research Ph.D. is 46, according to the nursing college association. Expanded loan forgiveness programs would also help aspiring faculty members stay the course of a doctoral program, Ms. Corcoran of the National League for Nursing said.

But there are some signs that the problems are getting attention. Last year Monster.com teamed up with the nursing college association to provide $25,000 scholarships for a year of doctoral education to individuals who agree to serve in a faculty role after they receive their degree. So far five have been awarded.

Recent legislation has also taken aim at the faculty squeeze. For example, in May 2005, Representative Rush Holt, a New Jersey Democrat, introduced legislation that would direct the Institute of Medicine to study and propose solutions to the constraints that nursing schools face in admitting students and the reluctance of nurses to enter faculty positions. The measure is pending in committee.

This June, Senator Richard J. Durbin, Democrat of Illinois, led an effort to adopt a pilot program to encourage nurses leaving the military to become nurse educators. The program was included in the Senate’s defense authorization bill, which is now in conference committee.

And on June 28, Senator Schumer introduced a law that would provide financial incentives for nurses to teach. Mr. Schumer’s legislation would create a prep program for nurses who want to join nursing faculties at schools in upstate New York — where he has identified a shortage of 6,000 nurses — and nationwide.

Polly Bednash, executive director of the nursing college association, is heartened by the legislative efforts. “The focus with the shortage of nurses has always been to get new nurses out there working,” she said. “But the key to solving the shortage is faculty. That’s the blockage in the pipeline.”

A version of this article appears in print on , on Page HW1 of the New York edition with the headline: For Lack of Teachers, Students Are Turned Away From Nursing. Order Reprints|Today's Paper|Subscribe